• MightyWELL Health Plan Accident Application

    Underwritten by Philadelphia American
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  • Primary Applicant

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    • Click next, if no spouse  
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  • Click next, if no child(ren)

    • Click to open child 1 application  
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    • Click to Open Child 2 Application 
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    • Click to Open Child 3 Application  
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  • Plan Selection and Benefit Levels

  • Minor Accident Benefit

    Covers minor accident and expenses that occurs 45 days of accident. NO deductible
  • Health Questions

  • Yes answers may increase premium. Your MightyWELL Representative will advise you of any price increase prior to billing.

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  • MightyWELL Representative

  • Beneficiary

  • Banking Information

  • Clear
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